Citation:Dermatology Online Journal 12 (7): 1 Title:Acetylator phenotype in iraqi patients with atopic dermatitis Rafid A Najim Department of Pharmacology, College of Medicine, University of Baghdad, Baghdad, Iraq. rafidnajim@yahoo.com Makram M Al-Waiz Rafi AM Al-Razzuqi Atopic dermatitis (AD) is a common multifactorial disease which has an itchy, recurrent, flexural and symmetrical eczematous eruption. There are reports that indicate that AD is associated with a predominantly slow acetylator status. This study was designed to determine the acetylator status in children with AD and compare it to a matched group of normal children. The study included 36 AD patients diagnosed clinically and 42 healthy controls. Detailed history was taken from the parents of each patient and disease severity was assessed using the Hanifin-Rajka scoring system. After overnight fast, each control subject and patient received a single oral dose of 50 mg of dapsone; a blood sample was collected after 3 hours and plasma separated for determination of dapsone and monoacetyldapsone by HPLC. The frequency of slow acetylators in the control group was 69.4 percent, and the frequency of rapid acetylators was 30.6 percent. The frequency of slow acetylators in AD patients was 72.2 percent and the frequency of rapid acetylators was 27.80 percent. There were no statistically significant differences between the control and AD patients groups. There was an association in AD patients between the acetylator status and family history of allergy as well as the severity assessed the Hanifin- Rajka scoring system. Although slow acetylators had lesions predominantly on the limbs, the distribution of lesions on the skin of rapid acetylators favored the face and neck. Although a slow acetylator status does not predispose to AD, it is associated with a different severity and distribution of the disease.

Citation:Dermatology Online Journal 12 [7]: 2 Title:Lactic acid 5 percent mouthwash is an effective mode of therapy in treatment of recurrent aphthous ulcerations Khalifa E Sharquie Scientific Council of Dermatology and Venereology, Iraqi Board for Medical Specializations. ksharquie@yahoo.uk.co Sami M Al-Tammimy Sabeeh Al-Mashhadani Raafa K Hayani Adil A Al-Nuaimy Background: Recurrent aphthous ulcerations (RAU) are the most common oral mucosal disease among the general population including in Iraq. There is no uniformly effective therapy for this disease. Objective: To evaluate the therapeutic efficacy and safety of 5-percent lactic acid mouthwash in the treatment of patients with recurrent aphthous ulcerations. Methods: This is a single-blind controlled therapeutic study. We recruited 80 subjects with early-onset oral aphthosis from patients who attended Baghdad Teaching Hospital Department of Dermatology and Venereology in the period between April 2004 and April 2005. Of those subjects, 10 defaulted; the remaining 70 patients were divided into two groups, A and B. Subjects in group A (36 patients) were instructed to use 5-percent lactic acid mouthwash, one teaspoonful three times daily before meals. Subjects in group B (34 patients) were instructed to use placebo (distilled water mouthwash) in a similar way. Assessment of each patient of both groups was done by using oral clinical manifestation index (OCMI) before, after 3 days and after 7 days of therapy. Results: The mean of OCMI in group A started to decline after 3 days of therapy and attained statistically significant lower level after 7 days of therapy (p <0.05). The change in the mean OCMI of group B after 3 and 7 days of therapy was also statistically significant (p <0.05). However, the response rate (percentage of change in the mean) after 3 days of therapy in group A was 63.6 percent and in group B was 8.8 percent, and the response rate after 7 days of therapy in group A was 90.8 percent and in group B was 35.7 percent. The difference in the response rates after 3 and 7 days between groups A and B was statistically significant (p <0.05). No significant side effects were noticed apart from mild irritation in two patients using lactic acid. Conclusions: Lactic acid 5 percent mouthwash is a new effective mode of therapy for patients with RAU and had significantly reduced the signs and symptoms of the disease, especially when compared with placebo. The mechanism of action may be related to increasing spontaneous secretion of endothelial growth factor from keratinocytes.

Citation:Dermatology Online Journal 12 (7): 3 Title:Evaluation of leishmanin skin test and its relationship with the clinical form and duration of cutaneous leishmaniasis Giti Sadeghian Skin Disease and Leishmaniasis Research Center, Esfahan University of Medical Sciences, Esfahan, Iran Ali Momeni Amir Hossein Siadat Pedram Usefi Background: Cellular immunity plays a major role in natural defense against cutaneous leishmaniasis. The leishmanin skin test (LST) is one method of evaluating the infected individual's immune response to leishmania. Our objective in this study was to evaluate the relationship between positivity of the LST with duration of disease, clinical form, number of lesions, and age and gender of the patient. Materials and Methods: This open study was performed on 198 patients who were affected by cutaneous leishmaniasis before any treatment was administered. Following confirmation of the diagnosis of cutaneous leishmaniasis, relevant data were recorded, including age, gender, occupation, address, duration of disease, clinical form, location of the lesions, and the number of the lesions. After performing the leishmanin skin test, patients were treated for leishmaniasis according to the type and severity of the disease. For patients whose LST was initially negative, the test was repeated every 15 days. If the LST was still negative after 4 months, the test was repeated every 3 months; if the LST remained negative 12 months after the first test, the result was considered negative. The collected data were statistically analyzed using the SPSS program. Results: In 179 patients (90.4 %) the test was positive at the time of the first test. In 7 patients (3.8 %) it became positive during treatment, and in 12 patients (6 percent %) the test remained negative until the end of study. There was no significant relationship between the skin lesion number and the positivity of the leishmanin skin test (p = 0.98). There was no significant relationship between age group and diameter of the induration. All of the patients who had negative leishmnanin test at the 12 months followup visit had one lesion only. Conclusion: This study showed that there is no relationship between age, gender, or duration of disease with positivity of the LST or degree of positivity, but there is a significant relationship with the clinical form of cutaneous leishmaniasis at the final test (12 patients). This study showed that there is no significant relationship between positivity of LST and the type of treatment.

Citation:Dermatology Online Journal 12 (7): 4 Title:Psoriasis and hepatitis C treated with anti-TNF alpha therapy (etanercept) Roberto Cecchi Affiliations:Department of Dermatology, Spedali Riuniti, V. Matteotti 1, 51100 Pistoia, Italy. r.cecchi@usl3.toscana.it Laura Bartoli The treatment of severe psoriasis in patients with concomitant hepatitis-C virus infection is quite difficult because several systemic anti-psoriatic drugs are contraindicated owing to their liver toxicity. Recent observations in the literature suggest that etanercept is an effective and safe therapy for this setting of patients. We present a 45-year-old man with extensive plaque psoriasis and concurrent hepatitis C, successfully treated with 12-month etanercept monotherapy. Regular controls of hepatic enzymes and viral load during the treatment disclosed no worsening of baseline values. This case confirms that etanercept may be a safe option for the therapy of patients with psoriasis and hepatitis-C virus infection.

Citation:Dermatology Online Journal 12 (7): 5 Title:Dermatosis neglecta: A series of case reports and review of other dirty-appearing dermatoses Jennifer L Lucas North Eastern Ohio Universities College of Medicine, Rootstown, Ohio Robert T Brodell Steven R Feldman MD Localized scaling and hyperpigmentation is a common finding and often a diagnostic and therapeutic challenge. Dermatosis neglecta (DN) represents a failure to adequately clean or scrub the skin, often in an area of hyperesthesia or prior trauma. We identified five cases of DN in two clinical practices in just the past few years. The condition is characterized by scrupulous avoidance of scrubbing, leading to a buildup of hyperpigmented, adherent, cornflake-like scales. An alcohol swabbing provided diagnosis and prompt clearing. Washing with soap and a washcloth also often leads to clearing. Dermatosis neglecta should be considered in the differential diagnosis of hyperpigmented scale; alcohol swabbing can serve as a diagnostic and therapeutic tool.

Citation:Dermatology Online Journal 12 (7): 6 Title:Hidradenitis should not be renamed acne inversa Noah Scheinfeld Department of Dermatology St Lukes Roosevelt Hospital Center

Citation:Dermatology Online Journal 12 (7): 7 Title:Recent immunologic considerations regarding the itch and treatment of scabies Craig G Burkhart Medical University of Ohio at Toledo, and Ohio University College of Osteopathic Medicine, Sylvania, Ohio. cgbakb@aol.com Scabies continues to be a major public health problem. Recent findings reveal that thesse mites produce substances that modulate the host's immune response resulting in the latency period prior to symptoms. In terms of treatment, two cases of ivermectin resistance have come to fore in Australia in patients treated over fifty times with the agent. Additionally, work in the development of vaccination of hosts with antigenic midgut proteins of mites to control ectoparasitic infestations continues.

Citation:Dermatology Online Journal 12 (7): 8 Title:The many faces of phytophotodermatitis Hiram Larangeira de Almeida Jr Catholic and Federal University of Pelotas, Brazil. hiramalmeidajr@hotmail.com Valeria Magalhães Jorge Phytophotodermatitis is a common cutaneous phototoxic reaction produced by contact with a variety of plant substances, followed by sunlight exposure. Phytophotodermatits can simulate child abuse , impetigo, superficial lymphangitis, and larva migrans. The most frequent presentation is hyperpigmentation of the dorsum of the hands, but there are other less common findings such as blisters or lesions mimicking solar lentigines and melasma.

99999999999999 Citation:Dermatology Online Journal 12 (7): 10 Title:Keratoderma hereditarium mutilans (Vohwinkel syndrome) in three siblings Authors:Arfan ul Bari Affiliations:Combined Military Hospital, Muzaffarabad, AJK, Pakistan. albariul@yahoo.com Keywords: Hereditary palmoplantar keratoderma, keratoderma hereditaria mutilans, Vohwinkel's syndrome, Mutilating keratoderma, Honeycomb keratoderma Abstract: Vohwinkel syndrome or keratoderma hereditaria mutilans is a rare, diffuse, honeycombed, palmar and plantar keratosis usually accompanied by pseudoainhum near the distal interphalangeal creases. The syndrome is reported in three out of five siblings (two brothers and one sister), who developed this problem in early childhood. Citation:Dermatology Online Journal 12 (7): 11 Title:Treatment of mycosis fungoides using a 308-nm excimer laser: Two case studies Authors:John L Meisenheimer MD Affiliations:South Orlando Dermatology, Orlando, Florida. luckyj@msn.com Keywords:mycosis fungoides, patch-stage mycosis fungoides, cutaneous T-cell lymphoma, excimer laser, 308-nm wavelength, phototherapy, broadband UVB, narrowband UVB, case study Abstract: Early-stage mycosis fungoides (MF) is most commonly treated with skin-directed therapies such as topical steroids, phototherapy (broadband or narrowband UVB), photochemotherapy (psoralen plus UVA), topical nitrogen mustard, and total skin electron-beam irradiation. Recently, several small studies have demonstrated the efficacy of the 308-nm excimer laser in the treatment of early-stage MF. This xenon-chloride laser, which emits monochromatic excimer light at the 308-nm wavelength, has been approved by the Food and Drug Administration to treat psoriasis since 1997 and to treat vitiligo since 2001. We report two patients in which patch-stage MF was treated with a 308-nm excimer laser. Our findings confirm previous observations that the 308-nm excimer laser is a safe, effective, and well-tolerated therapy for early stage MF. Title:Irritant contact dermatitis from exposure to povidone-iodine may resemble toxic epidermal necrolysis Authors:Travis W Vandergriff MD[1], Carina A Wasko MD[1], Mary R Schwartz MD[2], Sylvia Hsu MD[1] Affiliations:1. Department of Dermatology, Baylor College of Medicine 2. Department of Pathology, The Methodist Hospital, Houston, Texas Keywords: Citation:Dermatology Online Journal 12 (7): 12 Citation:Dermatology Online Journal 12 (7): 13 Title:Disseminated cutaneous nocardiosis mimicking cellulitis and erythema nodosum Authors:Saira J George MD, Allison M Rivera MD, Sylvia Hsu MD Affiliations:Department of Dermatology, Baylor College of Medicine, Houston, Texas Keywords: Abstract: Infection with Nocardia asteroides is a rare, life-threatening infection, which is most commonly encountered in immunocompromised patients. Cutaneous involvement is usually seen with disseminated infection but may also occur as primary cutaneous nocardiosis. We present a case of an immunocompromised patient who presented with cellulitis of the right hand and disseminated subcutaneous nodules of the lower extremities resembling erythema nodosum. Cultures from both a skin biopsy of a subcutaneous nodule on the leg as well as a surgical specimen from the debridement of her hand grew Nocardia asteroides. The patient was treated successfully with trimethoprim-sulfamethoxazole. This case likely represents primary cutaneous nocardiosis with secondary dissemination, which has been rarely reported. It also emphasizes that nocardial infection should be considered in the differential diagnosis of lesions suggestive of cellulitis or erythema nodosum in the severely immunocompromised patient. Citation:Dermatology Online Journal 12 (7): 14 Title:Granuloma inguinale: A case report Authors:Rashid M Rashid [1], Shahbaz A Janjua MD[2], Amor Khachemoune MD[3] Affiliations:1. Loyola Stritch School of Medicine, Chicago, IL 2. Ayza Skin & Research Center, Lalamusa, Pakistan 3. Department of Dermatology, State University of New York Downstate Medical Keywords: Granuloma inguinale, Donovanosis, genital ulcer Abstract: Granuloma inguinale is common in certain regions of the world, however, it is rarely reported in the United States. It is the result of infection by Calymmatobacterium granulomati, although current literature proposes to re-classify this organism as Klebsiella granulomati. Here we report a case of granuloma inguinale, review the literature, and discuss historical context, treatment options, and differential diagnosis. Citation:Dermatology Online Journal 12 (7): 15 Title:Three cases of toxic skin eruptions associated with methotrexate and a compilation of methotrexate-induced skin eruptions Authors:Noah Scheinfeld Affiliations:Dept of Dermatology St Lukes Roosevelt Hospital Center, New York, NY. Scheinfeld@earthlink.net Keywords:Methotrexate, acral erythema, Burkitt's lymphoma, abortifacient, drug eruption, chemotherapy Abstract: Methotrexate is an antimetabolite used as a treatment for a variety of neoplastic and inflammatory diseases. It has a variety of cutaneous side effects, in particular when administered in high doses. This is a report of cutaneous eruptions in three patients treated with methotrexate and a review of eruptions linked to methotrexate. Citation:Dermatology Online Journal 12 (7): 16 Title:Neonatal lupus Authors:David T Robles MD PhD[1], Lorena Jaramillo MD[2], Robin L Hornung MD[3] Affiliations:1. Department of Medicine, Division of Dermatology, University of Washington Medical Center, Seattle, WA 98105
2. Department of Obstetrics and Gynecology, Group Health Cooperative, Seattle, WA
3. Department of Pediatrics, Division of Dermatology, Children's Hospital and Regional Medical Center, Seattle, WA 98105 Keywords: Neonatal Lupus, Lupus Erythematosus, Abstract: An otherwise healthy 5-week-old infant with erythematous plaques predominantly on the face and scalp presented to our dermatology clinic. The mother had been diagnosed with lupus erythematosus 2 years earlier but her disease was quiescent. Neonatal lupus is a rare condition associated with transplacental transfer of IgG anti-SSA/Ro and anti-SSB/La antibodies from the mother to the fetus. Active connective tissue disease in the mother does not have to be present and in fact is often absent. Although the cutaneous, hematologic and hepatic manifestations are transient, the potential for permanent heart block makes it necessary for this to be carefully ruled out. As in this case, the dermatologist may be the one to make the diagnosis and should be aware of the clinical presentation, work-up, and management of this important disease. Citation:Dermatology Online Journal 12 (7): 17 Title:Generalized granuloma annulare resolving to anetoderma Authors:Ummuhan Kiremitci[1], Serife Karagulle[1], Elif Topcu[1], Mehmet Salih Gurel[1], Sila Seremet Erdogan[1], Asli Turgut Erdemir[1], Alper Alyanak[1], Cuyan Demirkesen[2] Affiliations:1. Dermatology Clinic, Istanbul Training and Research Hospital, Istanbul, TURKEY 2. Department of Pathology, Istanbul University, Cerrahpasa Medical Faculty, Istanbul, TURKEY Keywords:Granuloma annulare, anetoderma, diabetes mellitus, PUVA Abstract:Granuloma annulare is a benign, degenerative skin disease; the generalized form is rare. The question of an association between generalized granuloma annulare and other internal diseases has been a matter of debate for many years. In this report, we present a 54-year-old latent diabetic patient with generalized granuloma annulare who developed anetoderma during its treatment. Citation:Dermatology Online Journal 12 (7): 21 Title:Cerebriform nevus sebaceus: A rare entity Authors:Veena Maheshwari MD[1], Kiran Alam MD[1], Smriti Prasad MD[1], Rajeev Sharma MD[2], AH Khan MCh[3], Preeti Sood MD[1] Affiliations:1. Department of Pathology, Jawaharlal Nehru Medical College and Bishen Skin Centre, Aligarh. saanjulimaheshwari@yahoo.co.uk 2. Department of Skin and Venereal Disease, Jawaharlal Nehru Medical College and Bishen Skin Centre 3. Department of Plastic Surgery, Jawaharlal Nehru Medical College and Bishen Skin Centre Keywords: Cerebriform, nevus sebaceus Abstract: We present a case of cerebriform nevus sebaceus in an 18-year-old boy. This form of nevus sebaceus is quite rare, in contrast to the relatively common linear variant. Citation:Dermatology Online Journal 12 (7): 22 Title:Segmental neurofibromatosis in association with a large congenital nevus and malignant melanoma Authors:Sean D Doherty [1], Saira George MD[2], Victor G Prieto MD PhD[3], Jeffrey E Gershenwald MD[4], Madeleine Duvic MD[5] Affiliations:1. Baylor College of Medicine, Houston, TX 2. Department of Dermatology, Baylor College of Medicine, Houston, TX 3. Departments of Dermatology and Pathology, The University of Texas, MD Anderson Cancer Center, Houston, TX 4. Department of Surgical Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX 5. Department of Dermatology, The University of Texas, MD Anderson Cancer Center, Houston, TX. mduvic@mdanderson.org Keywords:Melanoma, neurofibromatosis, large congenital nevus Abstract:We describe a patient with segmental neurofibromatosis and a large congenital nevus who developed malignant melanoma in the same anatomic distribution. The overlapping presentation suggests a common etiologic link between neurofibromatosis and large congenital nevi and the possibility that neurofibromatosis increases the risk of melanoma with large congenital nevi. Citation:Dermatology Online Journal 12 (7): 23 Title:Calcinosis cutis complicating liver transplantation Authors:Amir Houshang Ehsani MD, Robabeh Abedini MD, Maryam Ghiasi MD, Mahbubeh Sadat Hoseini MD Affiliations:Tehran University of Medical Sciences, Department of Dermatology, Razi Hospital, Tehran, Iran. mghiasi@razi.tums.ac.ir Keywords: calcinosis cutis, calcification, liver transplantation Abstract: We report a case of calcinosis cutis in a 41-year-old man developing after liver transplantation at sites where no intravenous calcium had been administered. The cutaneous lesions developed on his right upper arm 10-days post-transplantation. The patient had received calcium chloride solution intravenously after surgery. We excluded other causes of ectopic calcification such as hyperparathyroidism, renal failure, and extravasation of calcium chloride. Citation:Dermatology Online Journal 12 (7): 24 Title:Ulcus cruris associated with prolidase deficiency Authors:Mukaddes Kavala, Ilkin Zindanci, Sibel Sudogan, Zafer Turkoglu, Sukran Sarigul Affiliations:Department of Dermatology, Goztepe Training Hospital, istanbul, Turkey. drilkinzindanci@yahoo.com Keywords:Prolidase deficiency, ulcus cruris, leg ulcer Abstract: Prolidase deficiency is an autosomal recessive disorder that is associated with chronic cutaneous ulcers, mental retardation, unusual facial appearance, skeletal deformities, joint dislocations, hematological anomalies, splenomegaly, and chronic infections. The most typical finding is chronic, recurrent leg ulcers appearing in early childhood. Prolidase (peptidase-D) is necessary for collagen biosynthesis and its deficiency leads to impairment in connective tissue of the skin, capillaries, and lymphatic vessels. We report a 33-year-old woman who had a 15-year history of nonhealing ulcer on left pretibial region accompanied by splenomegaly, hypochromic microcytic anemia, and thrombocytopenia. Prolidase deficiency is a rare genodermatosis and must be considered in the differential diagnosis of leg ulcers that develop at an early age. Citation:Dermatology Online Journal 12 (7): 25 Title:Syphilis: a forgotten disease? Authors:M Konstantopoulou[1], U Andrady[2], M G Lord[3], A W Macfarlane[1] Affiliations:1. Department of Dermatology1, 2, and 3, Ysbyty Gwynedd Hospital, Bangor, UK. Maria.Konstantopoulou@nww-tr.wales.nhs.uk 2. Department of Genitourinary Medicine, Ysbyty Gwynedd Hospital 3. Department of Pathology, Ysbyty Gwynedd Hospital Keywords: syphilis, HIV Abstract: We report a case of secondary syphilis in a 54-year-old, bisexual, HIV positive man. Although syphilis is a well-known sexually-transmitted infection, it is not widely seen nowadays. However, a possible diagnosis of syphilis should not be overlooked in any individual, irrespective of HIV status. Citation:Dermatology Online Journal 12 (7): 26 Title:Lymphocytic infiltrate of Jessner Authors:Vandana Mehta Rai MD DNB, C Balachandran MD Affiliations: Department of Skin and STD, KMC Manipal. vandanamht@yahoo.com Body: Citation:Dermatology Online Journal 12 (7): 27 Title:Erythema nodosum leprosum: A presenting manifestation of lepromatous leprosy Authors:Vandana Mehta MD DNB, C Balachandran MD Affiliations:Deptartment of Skin and STD, Kasturba Medical College, Manipal, Karnataka, India. vandanamht@yahoo.com Citation:Dermatology Online Journal 12 (7): 28 Title:Methotrexate, hyperosmia, and migraine Authors:Omid Zargari MD Affiliations:Booali Medical Group, Rasht, Iran. ozargari@iranderma.com Keywords: Psoriasis, methotrexate, hyperosmia, neurotoxicity